pacemaker too sensitive? help...

I have a question that I asked my doctor at the hospital after my first night with the pm which was three weeks ago. I didn't really get an answer and it is still bothering me.
My heart rate will drop and pacemaker will send a volt and then heart rate jumps up to 80 or 90. Then it will work it's way back down and pacemaker will send a volt and heart jumps up again like it got shocked almost. This goes on and on for hours somketimes. It is very distracting. The doctor said that it was my heart doing that not the pacemaker. Well I know it's my heart but the pacemaker is causing it. It seems like it almost scares my heart if that makes sense. Can this be fixed?? I go for my first check-up on Thursday.

8 Comments

Pacemaker

by SMITTY - 2009-05-24 05:05:11

What you are describing doesn't sound like what we normally expect a pacemaker to do. However, before saying another word, I am not saying it is not caused by your pacemaker, I know better than to ever make the statement that a pacemaker will or will not do anything.

But the job of a pacemaker is to monitor your heart and if your heart rate drops below the low set point on your pacemaker then it will send an impulse to bring your heart back up to that low set point and continue sending impulses to keep the heart rate at that level. Of course if you are involved in some physical activity. In that case if the rate response is on, then the PM will cause your heart rate to go on up. You'll have to ask the doctor if your rate response is on.

Now for a guess on what you describe. That sound like you may be having some A-Fib or V-Fib that is causing the increased heart rate. Your pacemaker will do nothing to start or stop them. Either A-Fib or V-Fib is for your doctor to help with.

When you go for your checkup tell the doctor, nurse, technician what is going on and see what they have to say.

Good luck,

Smitty

programming

by Tracey_E - 2009-05-24 05:05:21

I don't know why you got your pm so it's hard to say what it could be. Are you pacing atrial or ventricular? If you're pacing ventricular, your own sinus node (in the atria) is setting the pace, the pm just kicks in when the ventricle doesn't follow, so any increases are your natural rhythm. A pm can't slow down your heart, it can only speed it up.

There is something called pvc- premature ventricular contractions. I can't explain it well, but if you google it or look through the help files here you'll get an explanation. They feel funky but they're harmless, and a pm can't do anything about them.

Pacemaker's aren't programmed by beats per minute, but by second. So, if your minimum setting is 60, that works out to one beat per second. If your heart goes a second without beating, the pm kicks in and generates a beat. If your heart does two beats in a second, pm will just watch because you're over the minimum setting, which is what's happening when your rate jumps up to 80 or 90. The only way the pm would artificially raise your rate is if you have rate response on, that setting will make your heart speed up when it senses movement. This is for people who pace atrial.

They can turn down the voltage if it's too high, though I don't think having it too high would cause what you describe.

I have something called chronotopic incompetence (spelling is probably way off, but it sounds like that!) where my heart speeds up on its own to 150 or so when I'm working out, then suddenly drops off to 120, then goes back up again a few seconds later. The sudden drops made me dizzy. Since all of it was over my minimum rate (60) and my sinus node is setting the pace, the pm didn't do anything about it but make sure the ventricles kept up with the crazy roller coaster the atria were doing. I think the setting is called rate drop or something like that, when they turned it on, I felt a lot better! Now my hr can still drop (like when I'm done working out) but the pm makes sure it doesn't drop too quickly so those quick dips are gone.

It can take a few tries to get the programming just right. Have patience with them! Be sure to write down your symptoms, and the time it happens can be helpful too.

thank you for your comments

by nat36 - 2009-05-24 05:05:24

My pm is pacing my sinus node if that makes any difference. I am at a loss also as to what could be causing this. I do have rate response on but this is not when I am active that this is happening. I can falways eel it when the pm kicks in and it feels like it is only kicking in once when this is happening and then kind of jolts my heart too much and causes it to jump immediately higher from the jolt not from it pacing it that high, you know? I guess that doesn't make much sense and it is hard to describe. Can everyone feel it when their pm kicks in? I just feel like the volts are set too high...maybe:)
Who knows, it is all so confusing to me. I just wish I could get it right. It seems like my rate response is too sensitive also because just vibration from loud noise or minimal movement will make it kick in. Do you think that these things can be fixed or will I just have to adjust to them? I just want to NOT think about my pm all the time, you know?

thank you all!

by nat36 - 2009-05-24 06:05:03

It is so great to at least be able to come here and vent and get some feedback from people who have been where you are...
I did have some some fast rates from the ventricles when my sinus node was not functioning before the pm. The doctor said that usually those beats are always slow but mine were fast sometimes. Before the pm my sinus node was only working about 20% of time after the ablation and mostly my rates were staying in the 40s and 50s but sometimes they would go 80s and 90s and still be beating from the ventricles. The doctor said the pacemaker would not stop those high rates. So what would? I think it is maybe a mixture of that and the rate response being too sensitive but I need the rr because my heart does not respond on it's own sometimes. When you go for a check can they tell all the abnormal beats you have had? Does the pacemaker record everything?? Sorry for all the questions and the whining!!!

pacing

by Tracey_E - 2009-05-24 06:05:43

I read some of your other posts, it sounds like you're getting some random beats from the ventricle, in which case there isn't much you can do about it. Usually the sinus node in the atria sets the pace, it tells the av node in the ventricles when to beat. That's a normal beat. If the ventricles never get a signal, they will beat on their own at some random pace. I think that's called idionodal rhythm. This is how my heart beat before I got my pm. I have a complete block so the signal from atria to ventricle almost never gets through. My hr was 45 all the time before I got the pm, all beats generated from the ventricles. All of us have an intrinsic rhythm we'd have without the pm, most of us it's too slow to keep us going (why we have the pm's!) but it sounds like yours is fast sometimes. If you just had an ablation, it may settle down.

Most cannot feel the pm when it kicks in. The voltage is not high enough to feel, even when it's turned up. It doesn't take much to get the heart to beat, it's a very small jolt.

Rate response can be adjusted to be less sensitive to movement. If minimal movement is making it kick in, I'd ask to have it turned down.

You WILL get to where you don't think about it all the time! It sort of takes over at first, especially when you aren't feeling your old self yet. It'll come!

My take...

by chip - 2009-05-24 06:05:48

Sounds like you’re having a pretty tough time – I’m sorry for that.

It can sure be hard to get these devices set just right and it can take a few trips to the doc to get it done.

I believe that you are feeling the rate response feature of your pacemaker kick in. I say this because when I first received my pacer I experienced something similar to what you describe. I can be setting still and just tap on my pacemaker and my heart will speed up from the rate response feature. I got used to it and the feature enables me to do a little more.

Like the others have said I’d explain it all to the rep or doctor at your next appointment. Could be you would be better off with the feature turned off.

But remember we are not doctors and if you feel too out of sorts might I suggest a trip to the ER just to be safe.

Best of luck & God Bless

reports

by Tracey_E - 2009-05-24 07:05:10

The pm doesn't work like an ekg, it doesn't tell every time you had irregularities. It will tell how often the pm is in use, any time you max out, anytime the pm does anything weird, thresholds, battery use. If your heart speeds up on its own, the pm memory will not catch that unless it's pacing. For instance, in my case sometimes my rate shoots up (svt's) but it's generated from the atria and the pm makes the ventricles keep up, so that shows up in the report. If the ventricles beat on their own, it won't show up on the report. Only an event monitor (Holter) can tell you everything your heart is doing.

If you had a sinus node ablation, the pm is setting your pace and you do NOT want RR turned off. RR is what will enable your hr to go up with exercise. It is common for it to take some experimenting to find the balance between responsive enough to go up when you need it to and not shooting up every time you sneeze.

The only things that will slow down the ventricles would be an av node ablation, which would very much be a last resort. If the high rates are annoying but not dangerous, you don't want to go there. Betablockers slow down a fast hr, but I don't know enough about how they work to know if they'd slow you down.

You're not whining :o) Wanting to understand is healthy, ask away. And vent all you want also, get it out among those of us who've been there.

Thanks so much Tracey

by nat36 - 2009-05-25 04:05:41

Ok, so I will have to tell the doctor about the the high rates from the AV node. Maybe there is medicine that could calm that down some. Thank you for explaining how the check-ups work. I guess this all just takes some patience (not my strong point) on my part:)
As for the RR, I know I need it. Before I got the ablation if I walked up the stairs my heart rate would not go up at all and I would feel like I was going to black out. No more of that so I know it's helping. Like you said, I just need to get it right.
Thank you SO much! I try not to harp on this thing in my chest but it's hard especially when you are not sure how it is working!

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